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The BHNS hair has organised a monthly Journal Club with reviews and analysis on a range of publications.

July 2018 - Hair and Nail Papers

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Megan
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BHNS July 2018 hair and nail papers journal review

Dr Megan Mowbray and Dr Nicky Salmon

 

Clinical and Experimental dermatology, July 2018

 

1 x correspondence:

 

Rapid improvement of nail matrix psoriasis with apremilast: clinical and ultrasonographic assessment. Doi: 10.1111/ced.13411.

 

C. Munoz-Santos, J. Sola-Ortigosa and A. Guilabert

 

This is a case report of a 57 year old gentleman with a 10 year history of palmoplantar psoriasis affecting all toenails, previously treated with multiple systemic and biologic agents unsuccessfully.  He was prescribed apremilast resulting in an improvement after 12 weeks of therapy. Medical photographs show an improvement, NAPSI score for the toenails and the right great toe nail decreased from 44 to 10  and 6 to 2, respectively and ultrasonography of the target nail revealed an improvement of nail matrix disease.  Further studies with larger sample sizes are need to confirm these findings.

 

Journal of the American Academy of Dermatology, July 2018

 

1 x letter to the editor:

 

Descriptive survival study of nail melanoma patients treated with functional surgery versus distal amputation. 

 

S Montagner, F Aparecido Belfort, W Belda Junior and N Di Chiacchio.

 

This was a retrospective study carried out in a public and private dermatology department in Brazil. 21 patients with nail melanoma between 2003 and 2013 were included. Patient sex and age, tumour characteristics, surgical technique used (either phalangeal amputation or local excision where the visible tumour was removed with a 5mm margin), follow-up length of time after surgery and outcome were recorded. They found that none of the variables studied had a statistically significant impact on survival.   This study is in keeping with other reports in the literature that conclude that the surgical approach does not affect the prognosis of nail melanoma.  However, it differs to other published work that shows that histologic characteristics (eg tumour thickness) are prognostic factors for nail melanoma.   The authors point out this difference is possibly due to a small sample size in this study.

 

1 x online notes and comments:

 

Alopecia areata

 

S R Lipner and R K Scher.  July 2018 volume 79, issue 1, pages e9-e10

 

This is a commentary about a review article written by Strazzulla et al which was published in January’s JAAD on the presentation and treatment of alopecia areata. The authors state that nail changes are present in up to 66% of patients with a diagnosis of alopecia areata, with an average prevalence of 30% (more than the 10-20% figure quoted by Strazzulla et al).  They describe the less common nail changes that can be seen including Beau lines, onycholysis, punctate leukonychia, mottled lunulae, onychomadesis, distal notching, lamellar splitting, ragged cuticles, onychorrhexis and yellow-brown discolouration.  A photo showing shallow nail pitting in a grid like distribution (the most common finding in children and adults) and a photo showing severe onychodystrophy with nail plate crumbling are included. The presence of nail changes in patients with alopecia areata may suggest likely progression to a more severe form such as alopecia areata totalis or universalis. In children nail changes may improve spontaneously and observation may be appropriate. In adults with onychodystrophy, treatment with topical steroids and tazarotene, intralesional matrix injections with triamcinolone and systemic steroids have been used with varying efficacy.  They suggest a complete nail examination in all patients with hair loss and recommend asking about the impact of the nail disease on daily functions.

 

JEADV, July 2018

 

Increased prevalence of vitamin D Deficiency in patients with alopecia areata: a systematic review and meta-analysis.

 

S Lee, BJ KIM, CH Lee, WS LEE.

 

The aim of this study was to asses the difference in the mean vitamin D level and compare  prevalence of vitamin D deficiency between AA patients and non-AA patients. A systematic review and metanalysis of observational studies about AA and serum vitamin D level and/or prevalence of vitamin D deficiency was done searching MEDLINE, Cochrane, Web of Science and Google Scholar databases.   In all, 14 studies including a total of 1255 AA subjects and 784 non‐AA controls were analysed. The mean serum 25‐hydroxyvitamin D level was significantly lower in AA subjects (−8.52 ng/dL; 95% confidential interval; −5.50 to −11.53). The AA subjects had higher odds of vitamin D deficiency (odds ratio of 3.89; 2.02 to 7.49, mean prevalence of 73.8%; 59.1 to 84.6%). The authors concluded that the AA subjects had lower serum vitamin D levels and vitamin D deficiency was highly prevalent compared to non‐AA controls. This leads them to suggest that vitamin D deficiency should be assessed in AA patients and that nutritional supplementation of vitamin D or topical vitamin D analogues can be considered for AA patients with vitamin D deficiency.

 

1 x letter to the editor:

 

Frontal fibrosing alopecia after antiandrogen hormonal therapy in a male patient.

 

A Lobato-Berezo, A March-Rodrigues, G Deza, M Bertolin-Colilla and RM Pujol.

 

This is a case study of an otherwise healthy 82 year man with prostate adenocarcinoma who was treated with antiandrogen therapy (oral bicalutamide 50 mg daily and subcutaneous goserelin 10.8mg 3 monthly) for 8 years before developing biopsy proven frontal fibrosing alopecia. The authors conclude that low serum androgen levels, secondary to blockage by bicalutamide and goserelin, might play a role in the induction of FFA.

 

Journal of Investigative Dermatology, July 2018

 

1 x original article:

 

An Open-Label Pilot Study to Evaluate the Efficacy of Tofacitinib in Moderate to Severe Patch-Type Alopecia Areata, Totalis, and Universalis

 

A. Jabbari, F. Sansaricq, J. Cerise, J.C. Chen, A. Bitterman, G. Ulerio, J. Borbon, R. Clynes, A.M. Christiano and J. Mackay-Wiggan

 

This group previously performed whole genome expression studies that identified immune pathways mediated through JAK kinases hence their ongoing work with small molecule JAK inhibitors.  In preclinical trials in mice, tofacitinib (a potent selective JAK inhibitor) successfully prevented AA development and reversed established disease. In this tofacitinib trial in 12 patients with moderate to severe AA, 11 patients completed a full course of treatment with minimal adverse events. Following limited response to the initial dose (5 mg BD), the dose was escalated (10 mg BD) for nonresponding subjects. Eight of 12 patients demonstrated 50% hair regrowth, while three patients demonstrated < 50% hair regrowth, as measured by Severity in Alopecia Tool scoring. One patient demonstrated no regrowth.  They conclude that treatment with tofacitinib lead to dramatic clinical responses in moderate to severe AA, providing strong rationale for larger clinical trials using JAK inhibitors in AA.

 

1 x letter to the editor:

 

Peroxisome proliferatore activated receptor-gL mediated signaling regulates mitochondrial energy metabolism in human hair follicle epithelium.

 

Y Ramot, M Alam,, A Ola´h, T Bı´ro´,L Ponce, J Che´ret, M Bertolini and R Paus

 

This group report a series of experiments investigating peroxisome proliferator-activated receptors (PPARs).  These are ligand-activated transcription factors which belong to the family of nuclear hormone receptors.  Their results show that, similar to its effects in other tissues, PPAR mediated signaling is a player in regulating the energy metabolism of human scalp hair follicles by enhancing mitochondrial function, most probably primarily in the ORS keratinocytes. They hope to translate this into clinically beneficial effects such as anti hair follicle aging.

 

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